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Adherence to hospital drug formularies and cost of drugs in hospitals in Denmark

  • Pharmacoepidemiology and Prescription
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European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

To investigate adherence rates to hospital drug formularies (HDFs) and cost of drugs in hospitals.

Methods

Data on drugs used during 2010 were analyzed for ten hospitals (two hospitals from each of the five regions), constituting 30 % of hospitals and 45 % of hospital beds in Denmark. Drug use data from individual hospitals were retrieved from the hospital pharmacies. Adherence to the HDFs was analyzed for selected substances characterised by extensive use both in primary and secondary sectors (ATC codes A10, B03, C03, C07, C08, C09, C10, J01, N02, N05 and R03). Within each group, we also identified the drugs constituting 90 % of the volume (= DU90%) and the adherence to the HDF in this segment (Index of Adherence).

Results

Substances used by hospitals varied between 598 and 1,093. The proportion of used substances that were on the HDF varied between 14 % and 44 %. University hospitals used a significantly higher total number of substances (median 165 vs. 139, p = 0.019) and cost/DDD [(median 5 vs. 2 Euros, p = 0.033), p = 0.033] in the DU90% segment than the regional hospitals. Index of adherence varied between 43 % and 91 %. For the selected ATC codes, the index of adherence was between 76 % and 100 %.

Conclusions

Adherence to the selected ATC groups was high, which means that the most commonly used substances are included in the HDFs, even though a variation existed. A large variation existed between the hospitals in the number of substances at HDFs.

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References

  1. Statens Serum Institut (SSI) (2012) Lægemiddelstatistik i Danmark 2007–2011. http://www.ssi.dk/Sundhedsdataogit/Dataformidling/Laegemiddelstatistikker/~/media/Indhold/DK%20-%20dansk/Sundhedsdata%20og%20it/NSF/Dataformidling/5%20aars%20statistik/Samlet%20salg%20af%20lægemidler%202007%202011.ashx. Accessed 1 December 2013

  2. Gallini A, Juillard-Condat B, Saux MC, Taboulet F (2011) Drug selection in French university hospitals: analysis of formularies for nine competitive pharmacological classes. Br J Clin Pharmacol 72:823–831. doi:10.1111/j.1365-2125.2011.03997.x

    Article  PubMed  Google Scholar 

  3. Wettermark B, Pehrsson A, Juhasz-Haverinen M, Veg A, Edlert M, Tornwall-Bergendahl G, Almkvist H, Godman B, Granath F, Bergman U (2009) Financial incentives linked to self-assessment of prescribing patterns: a new approach for quality improvement of drug prescribing in primary care. Qual Prim Care 17:179–189

    PubMed  Google Scholar 

  4. Lapointe-Shaw L, Fischer HD, Newman A, John-Baptiste A, Anderson GM, Rochon PA, Bell CM (2012) Potential savings of harmonising hospital and community formularies for chronic disease medications initiated in hospital. PLoS One 7:e39737. doi:10.1371/journal.pone.0039737

    Article  PubMed  CAS  Google Scholar 

  5. Gustafsson LL, Wettermark B, Godman B, Andersen-Karlsson E, Bergman U, Hasselstrom J, Hensjo LO, Hjemdahl P, Jagre I, Julander M, Ringertz B, Schmidt D, Sjoberg S, Sjoqvist F, Stiller CO, Tornqvist E, Tryselius R, Vitols S, von Bahr C (2011) The ‘wise list’- a comprehensive concept to select, communicate and achieve adherence to recommendations of essential drugs in ambulatory care in Stockholm. Basic Clin Pharmacol Toxicol 108:224–233. doi:10.1111/j.1742-7843.2011.00682.x

    Article  PubMed  CAS  Google Scholar 

  6. Halloway K., Green T, Carandang E, Hogerzeil H, Aing R, Lee D (2003) Drug and Therapeutics Commitees - A practical guide. WHO–World Health Organisation. http://apps.who.int/medicinedocs/en/d/Js4882e/. Accessed 12 January 2013

  7. Scroccaro G (2000) Formulary management. Pharmacotherapy 20:317S–321S

    Article  PubMed  CAS  Google Scholar 

  8. Tyler LS, Cole SW, May JR, Millares M, Valentino MA, Vermeulen LC Jr, Wilson AL (2008) ASHP guidelines on the pharmacy and therapeutics committee and the formulary system. Am J Health Syst Pharm 65:1272–1283

    Article  PubMed  Google Scholar 

  9. Fijn R, Brouwers JR, Knaap RJ, de Jong-van den Berg LT (1999) Drug and Therapeutics (D & T) committees in Dutch hospitals: a nation-wide survey of structure, activities, and drug selection procedures. Br J Clin Pharmacol 48:239–246

    Article  PubMed  CAS  Google Scholar 

  10. Wettermark B, Haglund K, Gustafsson LL, Persson PM, Bergman U (2005) A study of adherence to drug recommendations by providing feedback of outpatient prescribing patterns to hospital specialists. Pharmacoepidemiol Drug Saf 14:579–588. doi:10.1002/pds.1098

    Article  PubMed  Google Scholar 

  11. Bergman U, Risinggard H, Vlahovic-Palcevski V, Ericsson O (2004) Use of antibiotics at hospitals in Stockholm: a benchmarking project using internet. Pharmacoepidemiol Drug Saf 13:465–471. doi:10.1002/pds.898

    Article  PubMed  Google Scholar 

  12. Vlahovic-Palcevski V, Wettermark B, Bergman U (2002) Quality of non-steroidal anti-inflammatory drug prescribing in Croatia (Rijeka) and Sweden (Stockholm). Eur J Clin Pharmacol 58:209–214. doi:10.1007/s00228-002-0449-2

    Article  PubMed  CAS  Google Scholar 

  13. Wettermark B, Pehrsson A, Jinnerot D, Bergman U (2003) Drug utilisation 90 % profiles–a useful tool for quality assessment of prescribing in primary health care in Stockholm. Pharmacoepidemiol Drug Saf 12:499–510. doi:10.1002/pds.852

    Article  PubMed  Google Scholar 

  14. Calasan J, Mijatovic V, Horvat O, Varga J, Sabo A, Stilinovic N (2011) The outpatient utilization of non-steroidal anti-inflammatory drugs in South Backa District, Serbia. Int J Clin Pharm 33:246–251. doi:10.1007/s11096-011-9487-0

    Article  PubMed  CAS  Google Scholar 

  15. Mimica MS, Bergman U, Vukovic D, Wettermark B, Vlahovic-Palcevski V (2010) Impact of restricted amoxicillin/clavulanic acid use on Escherichia coli resistance–antibiotic DU90 % profiles with bacterial resistance rates: a visual presentation. Int J Antimicrob Agents 36:369–373. doi:10.1016/j.ijantimicag.2010.05.019

    Article  Google Scholar 

  16. Fijn R, de Jong-van den Berg LT, Brouwers JR (1999) Rational pharmacotherapy in The Netherlands: formulary management in Dutch hospitals. Pharm World Sci 21:74–79

    Article  PubMed  CAS  Google Scholar 

  17. Anagnostis E, Wordell C, Guharoy R, Beckett R, Price V (2011) A national survey on hospital formulary management processes. J Pharm Pract 24:409–416. doi:10.1177/0897190011407777

    Article  PubMed  Google Scholar 

  18. Duran-Garcia E, Santos-Ramos B, Puigventos-Latorre F, Ortega A (2011) Literature review on the structure and operation of Pharmacy and Therapeutics Committees. Int J Clin Pharm 33:475–483. doi:10.1007/s11096-011-9501-6

    Article  PubMed  Google Scholar 

  19. Fijn R, Engels SA, Brouwers JR, Knaap RJ, de Jong-van den Berg LT (2000) Dutch hospital drug formularies: pharmacotherapeutic variation and conservatism, but concurrence with national pharmacotherapeutic guidelines. Br J Clin Pharmacol 49:254–263

    Article  PubMed  CAS  Google Scholar 

  20. Plet HT, Hallas J, Nielsen GS, Kjeldsen LJ (2012) Drug and Therapeutics Committees in Danish Hospitals: a survey of organization, activities and drug selection procedures. Basic Clin Pharmacol Toxicol. doi:10.1111/bcpt.12028

    PubMed  Google Scholar 

  21. Danske Regioner (2011) RADS: rådet for anvendelse af dyr medicin. http://www.regioner.dk/Sundhed/Medicin/Rådet+for+Anvendelse+af+Dyr+Sygehusmedicin+RADS.aspx. Accessed 1 September 2011

  22. Danisk Health and Medicines authorities (2009) Analyse af sygehusmedicin. http://www.sum.dk/Aktuelt/Publikationer/~/media/Filer%20-%20Publikationer_i_pdf/2009/Analyse%20af%20sygehusmedicin.ashx. Accessed 12 January 2013

  23. WHO Collaborating Centre for Drug Statistics Methodology (2012) ATC/DDD Index 2010. http://www.whocc.no/atc_ddd_index/. Accessed 15 January 2013

  24. Bergman U, Popa C, Tomson Y, Wettermark B, Einarson TR, Aberg H, Sjoqvist F (1998) Drug utilization 90 %–a simple method for assessing the quality of drug prescribing. Eur J Clin Pharmacol 54:113–118

    Article  PubMed  CAS  Google Scholar 

  25. Thurmann PA, Harder S, Steioff A (1997) Structure and activities of hospital drug committees in Germany. Eur J Clin Pharmacol 52:429–435

    Article  PubMed  CAS  Google Scholar 

  26. Himmel W, Lonker B, Kochen MM (1998) Nonformulary drug requests at an academic hospital in Germany–the role of general practitioners’ long-term medication. Eur J Clin Pharmacol 54:41–46

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors would like to thank the hospital pharmacies in Denmark and Amgros I/S for given access to BiWeb. This made it possible to retrieve the data used for this study.

Conflict of interest

None declared.

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Correspondence to Hanne T. Plet.

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Plet, H.T., Hallas, J. & Kjeldsen, L.J. Adherence to hospital drug formularies and cost of drugs in hospitals in Denmark. Eur J Clin Pharmacol 69, 1837–1843 (2013). https://doi.org/10.1007/s00228-013-1540-6

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  • DOI: https://doi.org/10.1007/s00228-013-1540-6

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